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Thursday, June 13, 2013

Afterthis articlecame out, several people have asked me what I think of medication for illnesses such as PTSD (post-traumatic stress disorder). Sometimes, therapists suggest clients see a psychiatrist to look at the possibility of medication. What's a client to do?

First, I want to stress that decisions surrounding medication are personal and individual. They need to be made case by case. No one can say that one drug is the right answer for everyone with a certain condition. Not even doctors.

Second, as I've stated many times before, I'm not a professional therapist, psychiatrist, or...pretty much anything. I really don't know much about drugs and how they work. However, I am a professional fighter. I'm not saying that I have the right answer for any one person...except myself. All I can share is my personal experience, and I hope you find that helpful if you are currently dealing with this issue.

I don't have a lot of faith in medication. I watched my instigator take drugs for years, and not a whole lot of good came from it. "Crap" still happened. It didn't matter how many grams of aripiprazole or guanfacine she consumed; her behavior was still nowhere near something I could accept. So I started my own journey toward recovery with a very negative view of medication.

There are a couple of reasons doctors may prescribe medication for someone with PTSD, such as for panic attacks and depression. One of the most common reasons is for sleep. A widespread symptom of PTSD (as we've discussed) is debilitating nightmares or refusal to sleep. This was the reason my therapist recommended I consider medication. I felt like I wasn't safe enough to sleep at night; even if I was in a safe place, I would relive the traumas every night in my dreams just as vividly if not more so as when I had lived them awake. Sleep was not safe, and sleep was not restful. So, sleep wasn't an option.

Medication became an option after I went fourteen days without sleeping (this was shortly before I decided to leave the instigator). However, when I considered the hassle that would be involved, I decided against it. Honestly, I was afraid to lose control of my body once again, but this time, to medication. That fear lasted a long time. Five months after that sleepless fortnight, things got bad once again even though I was not directly involved in the same situation. This time, when my therapist recommended I visit the psychiatrist, I agreed. He prescribed Prazosin, which is a blood pressure medication. I took it a few times. It worked beautifully, but it worked very well. The first night I took it, I woke up for work the next morning and had to crawl down the hallway from the bathroom. It knocked me out for at least ten hours. For an active employee, that was a problem. I tried taking half of the pill, but since it was the smallest dosage they could give and the pills were just capsules of powder, it was difficult. Also, I was nervous about using a drug that treated a problem I didn't have (high blood pressure) just to make use of its side effects (drowsiness). I resorted to using the Prazosin if I'd not slept in days and caffeine was no longer effective.

The psychiatrist understood my difficulty and switched me to Clonidine, another type of blood pressure medication which has been used for easing everything from insomnia to withdrawal symptoms from drugs or alcohol to menopause. Clonidine knocked me out faster than Prazosin did, but I woke up feeling fuzzy. After a few weeks of Clonidine, I gave up on nightly use again. I have not used medication regularly since then, but I have used both Prazosin and Clonidine as needed (after the psychiatrist assured me this would be okay).

My main problem with medications commonly prescribed for PTSD is that they affect my body. That may sound strange, but think about it. Trauma occurs when something happens to you that you can't control. Medication affects your body in ways you may know about but cannot control. That's why I have such a hard time taking medication. I don't like giving up control.

I think it's fantastic that people are searching for a better drug for people struggling with PTSD. And if manipulating CB1 receptors through marijuana helps that, I'm glad scientists are looking for a way to make it more helpful. However, I don't think there's a miracle drug. Prazosin may work for some people; Clonidine for others. There are countless other medications that can help as well. But, once again, the decisions about whether to take medication or what medication to take need to be made case by case.

Some fabulous resources for this are out there. Your doctor or therapist can refer you to a psychiatrist. Going to a few different psychiatrists to get several opinions can be very helpful as well. Talk to other fighters and find out what works for them and why. And, as always, if you have any questions, contact me and I will give you contact information for people who know more than I do.

Monday, June 10, 2013

The first piece of pretentious wisdom every overbearing, annoying, sometimes infuriating, know-it-all imparts to you once they realize there's something "wrong" with you is

"You should really go to therapy."

Idiots.

(I know. I should tell you how I really feel.)

But for some reason telling people how you really feel is the end-all be-all in some minds for any type of problem. Some people think therapy is the answer, but they forget that the question is different for each person.

So, I present to you my thoughts on the therapy option.

First off, therapy is an option. It is not a mandate (unless there is a court order involved). Anyone forced into therapy will not benefit from it. The number one rule of therapy is that you only get out of it what you put into it. If a loved one really wants to help a fighter, he or she should let the fighter have control. My first excellent therapist once described trauma to me as someone else having control without your best interests in mind. If loved ones take control over the actions of the fighter, whether or not they have the fighter's best interests in mind, the fighter can easily relapse into trauma-reaction mode. That is certainly not helpful. It's much easier for me to consider therapy if it's presented to me as a possibility rather than as something I must/should/need to do.

Second, therapy is not necessarily all of the answer. As helpful as discussing problems can be, sometimes more action needs to be taken to solve those problems. While therapy helped me, it was not until I left my instigator that I could really get the help I needed. Actually leaving the situation was the key. Therapy pushed me toward that and helped me with the fallout from that, but I had to take an action outside of therapy for anything to get better.

Third, therapy is very diverse and specialized. There are many forms of therapy for PTSD. I have participated in your run-of-the-mill "let's talk about what's going on and take a second look at your perceptions" type of therapy. This was helpful, but it could have been much more so if the therapist I had at the time was different. (The two of us did not click well.)

My first excellent psychologist helped me with EMDR, Eye Movement Desensitization and Reprocessing. While I don't necessarily agree with everything posted on thiswebsite, the "For Laypeople" section does give a good overview of what EMDR entails. The idea behind this therapy for PTSD is that eye movement is connected to memory. My therapist would ask me to think about something that had happened as I listened to tones and visually followed her hand movements. It was an intensive therapy (I went twice a week), but it definitely was the kick-start I needed in getting rid of nightmares.

After moving away, I found a new therapist who specialized in Cognitive Behavioral Therapy. This form of therapy focuses on reprogramming your brain. When your brain goes through a thought pattern, it's much easier to go through that same pattern again. Trauma creates unhealthy patterns; CBT tries to re-pattern those automatic thoughts. Again, I'm not agreeing with everything on this website, but it will help explain CBT. My therapist and I would work through "Challenging Beliefs" worksheets, which asked what trigger started a panic episode, what my "stuck point" was (the unhealthy thought that my brain kept going to), and whether that stuck point was true or not. We also went through modules about topics such as trust, power, and intimacy and identified stuck points for each of those.

These are just two of the most common types of therapies for PTSD. There are many more. What works for one person may not work for another person. There is no one-size-fits-all form of therapy. Even for different times in life, different therapies can be better than others. So the diversity of therapies available make the idea of an omnipotent therapy ridiculous. Some work better than others at some times with some people.

Fourth, therapy experiences are reliant on the relationship between the psychologists and the clients. I've had some less-than-awesome psychologists (one of whom simply blamed my parents for everything wrong in my life) and some incredible psychologists (who have been some of the most vital parts of my support system). Discerning between the two is difficult. One good way to differentiate is to find reviews of different psychologists. Often talking to psychiatrists, family doctors, or members of support groups can help you find a good psychologist. Something that I've found helpful is to meet with the psychologist and get to know them. What type of clients do they see? Do they have experience with trauma survivors? What kinds of therapy do they do? Most important of all, determine what the dynamic is between the two of you. Do you trust them? Do you like them? Do you see them as your first line of defense in your fight, other than yourself?

All of these complications make the statement "You should go to therapy" simply frustrating for me to hear. There are a lot of factors that should go into the decision to go to therapy. While I know that I would not be where I am today without therapy, I also know that it's not the answer to everything. Each person and each situation is different. So if you want to suggest therapy to someone, remember that it's an option that might be helpful but is very diverse and is reliant on the therapy relationship.

But what if a therapist suggests some additional type of treatment, especially medication?

Wednesday, June 5, 2013

At my most recent counseling center intake, I filled out a questionnaire that had over two hundred questions asking me about my self-image, my ideas about others, any tendencies I had that are "abnormal", and how much I ate/slept/exercised/etc. By the end, I felt like I had just run a marathon. And as the product of my time and effort, the computer spat out something I already knew very well: I had post-traumatic stress disorder.

My first really good psychologist asked me what was going on, heard me out, and then told me exactly the same thing. At one hundred ninety-nine questions fewer and more more personable, my psychologist's opinion was much easier to hear than that of the computer. However, either way, defining what criteria qualify someone as having PTSD is very difficult.

I say all this to apologize for this post. No writing on a blog (no matter who the source is or what experiences they have had) will ever replace a real-life excellent psychologist and his or her diagnosis. However, since certain reactions are normal after a trauma event, it can be very difficult to determine when you or someone you love has PTSD.

That's why I'm still writing. Maybe you're wondering about yourself. Maybe you're wondering about a loved one. Maybe you're just curious. No matter what your motivation, I can provide you some basic information about how PTSD can manifest itself.

About a fourth of the way down this web page, you will find an overview of the signs and symptoms of PTSD. While I do NOT agree with everything you will find on that page, the section entitled "Signs and symptoms of post-traumatic stress disorder (PTSD)" and the subsequent section entitled "Symptoms of PTSD in children and adults" are very consistent with my experience and research. The reason I chose this website is that it looks most similar to the questionnaire that I took (although don't worry; this site is much shorter).

There are three major categories of symptoms of PTSD. The first is reliving the experience. This includes, as the website says, flashbacks and nightmares. Nightmares were the reason I finally went back to counseling at the age of seventeen. I could not and would not sleep because of the intensity of the nightmares I experienced. Often, this first category is the most noticeable. It's not difficult to see when a car accident survivor has a flashback and freezes up because a bus came just a bit too close. My friends know just by looking at my face whether I've been sleeping or not.

The second category is avoiding anything that connects to the incident. This may be avoidance of emotions, places, or people. These symptoms are very difficult to identify as PTSD because these are very natural normal trauma reactions. To return to my former example, someone who has been injured in a car accident will be very reticent to drive again. For me, I used to strongly avoid discussing topics such as family. Because of the subtlety of these signs, it can be very difficult to distinguish between normal reactions and PTSD (more on this in a few paragraphs).

The third category is called "emotional arousal". As far as I have seen, this section is the one most constant in the fighter and least noticed by his or her loved ones. Once again, a car accident survivor may be constantly aware of his or her surroundings when on the road or may react strongly or jumpily when startled while on the road. For me, hypervigilance is the one symptom that has not drastically improved since I got out of the situation. I still am constantly aware of where everyone in the room is. I still habitually look around me as I walk. I still pay attention to where people's hands are, especially if people are upset. These are examples of typical emotional arousal.

So, the first category is easiest to recognize from the outside. The second is difficult to distinguish between a normal reaction and a reaction magnified by PTSD. The third is often only noticed by the individual himself or herself. How does one actually determine whether someone may have PTSD or is recuperating normally from a trauma event?

The only answer we seem to have right now is time. The generally accepted rule is that if someone has been experiencing symptoms from these three categories for longer than three months, they have PTSD. This can be a very frustrating answer because many people just want to know right now. The key is to remember that for any problem, whether it be cancer or PTSD or Alzheimer's, getting a diagnosis takes time. The plan of action I recommend the most is to see a professional. A professional is probably familiar with PTSD, and familiarity fosters recognition. That is why going to a professional the best way I know to determine whether you or a loved one has PTSD.

Sunday, June 2, 2013

June is National Post Traumatic Stress Disorder Month. Throughout the month, I will be posting helpful websites and resources for anyone who wishes to learn more about PTSD.

Let's start at the very beginning of PTSD: the trauma event(s). How are trauma and PTSD related? I think this link explains the connection very well. Basically, trauma is fairly common, but PTSD is much less common. There are certain factors which influence one's likeness to develop PTSD. Also, a large percentage of PTSD victims are in the armed forces, and this page gives a brief overview of recent military PTSD history.

The trauma event(s) are the beginning point of a journey which can be directed toward healing or toward destruction. As one of my therapists once told me, trauma is what happens when someone else has and exercises control over you without having your best interests in mind. This could be a one-time event or a recurring event over several years. Either way, the trauma event(s) have a profound impact on the person. Sometimes, that impact makes a person more grateful or cautious. Sometimes, it can bring them toward religion or away from crime. However, sometimes, that impact can lead directly to PTSD.

Thursday, May 2, 2013

Well, Purple Eyes is published! It has been an incredible journey. It's hard to believe that it was nearly seven years ago that I started writing some of the poems that are included in this book. Granted, there was a lot of editing that happened in those seven years, but I still feel like I have a time capsule to look back and remember everything that has happened and everything I have learned.

Even though I am excited about this incredible experience, I am ready to move on to the next project. As for what exactly that is, I am not sure yet. But I know that between writing and other forms of activism, I will find something.